Elements and Performance Criteria
- Evaluate and prioritise the needs of an older person with complex care issues
- Demonstrate understanding of the impact of dual/multiple diagnosis can have on identifying and prioritising needs
- In collaboration with a health professional, determine whether this person requires high level assessment prior to undertaking any evaluation activities
- Utilise purpose designed tools to assess specific problems of the older person according to job role and responsibilities
- Seek advice from health professionals as required to analyse and interpret assessment data
- Seek advice from appropriate personnel as required to determine service issues associated with assessment information
- Recognise the impact of complex care issues on the carer/s
- Identify indicators of elder abuse or neglect and respond appropriately in line with organisation guidelines
- Liaise and negotiate with appropriate personnel in the development of a service delivery plan
- Utilise best practice guidelines when choosing strategies to address complex and/or special needs
- Liaise with relevant experts when developing service delivery plans
- Negotiate and establish goals with the older person, their advocate/s and/or their significant other/s, aiming to achieve maximum quality of life
- Access and/or negotiate resources in order to deliver identified services
- Access community support agencies to facilitate the achievement of established goals
- Coordinate the delivery of the service delivery plan
- Delegate services and care activities to appropriately skilled workers
- Recognise when a service and/or care worker is no longer able to provide the level of service required
- Provide support and respite for the carer/s
- Determine all service providers' understanding of the service delivery plan and their roles and responsibilities within that plan
- Coordinate the monitoring, evaluation and review of the service delivery plan
- Determine all service providers' understanding of the mechanism/s for providing feedback on the effectiveness of the service delivery plan
- Seek feedback from all service providers when evaluating effectiveness of the service delivery plan and re-prioritising care needs
- Seek feedback from the older person and/or their advocate when evaluating effectiveness of the service delivery plan
- Seek advice and assistance from relevant health professionals when the older person's goals are not being reached